| NPI | 1710312533 |
|---|---|
| Former Name | MARY TEBO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: CT 5515) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CT 005515) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: CT 005515) | |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2019-04-24 |